Notes on Nursing

The most fundamental rule of ventilation and warming as they relate to health is that the patient’s air must be kept as fresh as possible without becoming too cold. Many consider open windows a source of illness (because of the possibility of catching cold while in a cold room and cold bed). However, patients can be kept warm and comfortable using basic preventive measures of proper bedding and hot water bottles. Common sense is enough to keep a room at a reasonable temperature, and the flow of fresh air can keep the room well ventilated, removing airborne sources of illness.

While these measures often don’t receive enough consideration, they’re usually least considered in places where they’re most necessary, like schools, factories, and places of work. When children gather together in classrooms or dormitories, they’re at high risk of illness due to the lack of fresh air. Places of work are susceptible to this too, and while employers are loathe to provide more space and accommodation to their employees, doing so would make them more productive because their health would improve.

The neglect of this simple measure is tragic, especially when talk of “mysterious dispensations” (12) meted out by God often replaces it. The bare necessities of health are comfortably in our own hands. Healthcare and nursing far too often ignore such common-sense measures, and carelessness is rampant. In addition to the need for fresh air and warmth is the need for pure air unfouled by items such as damp clothing or unemptied bed pans in the patient’s room. All of this is the nurse’s necessary and implicit duty.

The five most essential elements of a healthy home are pure air, pure water, efficient drainage, cleanliness, and light. Nightingale explicitly states that “without these, no house can be healthy” (18). When a child becomes ill, the first question that the adults often ask is where the child could possibly have caught it, but hardly anyone ever looks to the place that the child spends the most time: their own home. While many measures—such as vaccination—can help ensure health, an unhealthy home can undo them.

A clean house is necessary, and a dark house is a haven for illness. Again, the nurse can easily take care of these measures, and the idea that the causes of illness are completely out of our control is wrong. God has designed the means for our health, and it’s entirely our fault if we ignore them or leave them untried. In addition, the idea that certain families are more susceptible to illness has merit, but it’s not so much due to genetics as to the fact that some simply live in poor conditions and unhealthy houses. Moreover, certain demographics of people are more likely to get certain illness; for example, young women and soldiers are particularly susceptible to consumption (i.e., tuberculosis) because they tend to spend more time than most people in crowds and the cold night air.

Taking precautions and sanitary measures in public areas is one thing, but most people still neglect the necessity of similar measures within the home. This is a mistake: Keeping a clean, warm, and dry home is necessary for health and is the preferred method of preventing illness and disease. Contracting dangerous diseases is not a matter of fate; it can be largely prevented with the right care.

Something not entirely obvious to the public is the necessity for the nurse to be a capable manager. The nurse can’t be present for her patients 24 hours a day, so some level of management and delegation is necessary. Visitors to the sickroom—family, friends, or members of the help staff—must be carefully managed and controlled.

Tangential to this is the need to ensure that the sickroom doesn’t become a source of illness for the rest of the home. Therefore, the room must be aired by the windows and not by the door into the passageway to the rest of the home’s rooms. Returning to the main theme, the nurse must make the patient aware of the management measures and must never surprise the patient, as this could unnecessarily drain the patient’s energy. A patient who’s sure that the nurse is taking care of things well and managing them carefully will be at ease and use their energy to recover instead of to worry.

In some cases, the lack of proper management is not due to neglect but to the nurse’s pride, but that is a mistake. Nurses must ensure that the right thing is always done, not that the right thing is always done by their own hands. Many mistakes and tragedies can be traced back to the lack of someone in charge.

Simply put, unnecessary noise is harmful to a patient trying to heal and recover. Continuous and steady noise, however, is less harmful than sudden and unexpected noise, especially anything that wakes a patient from sleep: “[N]ever to allow a patient to be waked, intentionally or accidentally, is a sine qua non of all good nursing” (35). If a patient must be waked, it shouldn’t be shortly after falling asleep: Wait until the patient has been sleeping a few hours, because if they’re waked just after falling asleep, they’re far less likely to fall back asleep easily.

Patients can readily avoid many risks if their visitors are limited and monitored. Though most visitors have the best intentions, few genuinely understand how to act and what to say (or refrain from saying) in the presence of someone who is ill: Keep your voice low and level, refrain from speaking while moving, always stay in the patient’s line of sight, never keep a patient standing unnecessarily, and never surprise a patient. When those who are sick overexert themselves, they strain their bodies unnecessarily and can thereby set their recovery back substantially.

For the doctor or nurse, calmness is imperative, as a calm demeanor in the caretaker results in a calm demeanor in the patient; the reverse is also true. Reading aloud is often thought to help patients who are too weak to read on their own, but in nearly all instances those who are too weak to read also find it painful to concentrate on listening. Music, on the other hand, has a soothing effect.